Everything You Need to Know About Breast Cancer

"It's cancer" are two words no one ever wants to hear, but the encouraging fact is that the earlierbreast cancer is detected, the better the prognosis. The National Cancer Institute places the five-year survival rate at 100 percent if breast cancer is caught in stage 1. That's why it's so important to get screened regularly—but it seems the more we learn about screening methods, the more questions there are. Our experts explain the latest.

The Scoop on Screenings

Self-exams. Experts have moved away from offering instruction on how to do monthly self-exams. Now they're more likely to tell women to be more alert to how their breasts look and feel in general so they can detect any changes. "Research has shown that there are no significant benefits to doing monthly self-exams," explains Therese B. Bevers, MD, medical director of the Cancer Prevention Center at M.D. Anderson Cancer Center in Houston. "We don't want to confine women to a specific technique, frequency or time—it's more about your overall awareness." That said, if you want to do self-exams it can't hurt, and it may very well help catch some early tumors that might otherwise spread. Photo: Getty

"The official recommendation may be to skip it, but I tell my patients that as long as they're comfortable doing self-exams, it's for their own benefit," says Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology at Yale School of Medicine. Not sure of your technique? Ask your doc to explain what she's doing at your yearly checkup, when most gynecologists will perform a clinical breast examination.

Mammograms. You've no doubt heard about the controversy stirred by the U.S. Preventive Services Task Force: In late 2009, the group recommended that women who are not at high risk for breast cancer start getting mammograms at age 50 instead of 40. Then, in September 2010, a study published in the New England Journal of Medicine found that getting screening mammograms cut the risk of dying from breast cancer by 10 percent versus the 25 percent that previous studies had indicated.

So does that mean mammograms aren't worth it—or that you should wait until 50 to start having one? First of all, a 10 percent improvement in survival is still pretty significant. Also important to note: The New England Journal of Medicine study was done in Norway, and their health care system is different from ours so the results might not be applicable here, says Catherine Lee, MD, an assistant professor of surgery specializing in breast cancer at Moffitt Cancer Center in Florida. "Currently, about 50 percent of breast cancers in the U.S. are detected by screening mammography," says Dr. Lee. 

As for when to start getting screened, it's a conversation every woman should have with her doctor, but you should know that many experts—including the American Cancer Society and the National Comprehensive Cancer Network, an alliance of 21 leading cancer centers—say mammograms should still start at age 40. If you have a strong family history (a first-degree relative, meaning a parent, sibling or child, who has developed breast cancer) or have tested positive for a BRCA1 or BRCA2 gene mutation, experts recommend beginning even sooner, usually 10 years earlier than the youngest family case, but not before age 25.

"You need to balance the risks and benefits, and weigh the severe cost of missing cancer against that of extra mammograms and possible biopsies," says Dr. Bevers. "I strongly believe that if even one fewer woman dies from breast cancer because she went through the screening process, we should be telling our patients to get mammograms earlier, not later." Women in their 40s often have denser breasts than older women, which can make it harder to read their mammograms. But many centers now use digital mammography, which can make it easier to spot potential problems on denser breasts.

Sonograms. If you're at higher risk or have very dense breasts, your doctor may recommend getting an ultrasound (also called a sonogram) along with your annual mammogram. "There's a chance you'll find something on an ultrasound that you wouldn't see on a mammogram, but it's not nearly as sensitive as getting an MRI," says Dr. Bevers.

MRIs. Many cancer experts advise high-risk patients (those with a strong family history of cancer or a BRCA mutation) to get an annual MRI spaced 6 months apart from their annual mammogram. "MRIs are highly sensitive and can pick up cancers at a very early stage," says Dr. Bevers. But they also have a high level of false positives, and the process itself (you lie perfectly still in a confining tube-shaped scanner) can be unsettling. Talk to your doctor about which screening method is most suitable for you.

6 Musts for Every Woman to Lower Her Risk of Breast Cancer

Although you don't have total control over your risk for this disease, the American Institute for Cancer Research says that nearly 40 percent of all breast cancer cases in the U.S. annually could be prevented with lifestyle measures like eating right and exercising. Get started today:

1. Stay at a healthy weight. Research shows that post-menopausal women who are obese are 1.5 times as likely to develop breast cancer as their normal-weight counterparts, and are at a significantly higher risk of dying from the disease. Experts estimate that up to 18,000 deaths per year from breast cancer in women over age 50 might be avoided by maintaining a body mass index (BMI) of under 25 throughout adulthood. One potential reason is that fat tissue can produce estrogen. Too much of it raises your estrogen levels, thus increasing your risk of cancer. Photo: ThinkStock

2. Exercise. There's a benefit to getting a move on, no matter what you weigh. Research from the National Cancer Institute shows that exercising four or more hours a week can decrease estrogen levels and in turn help lower breast cancer risk. Make your workout intense and your risk will decrease by as much as 30 percent. Try taking a brisk 30- to 45-minute walk, bike ride, swim or kick-boxing class or doing some other form of aerobic activity five or six days of the week. Do two of those workouts in intervals, increasing the intensity for a few minutes at a time, or pick up the pace for most of the session (jog instead of walk, ride a few miles per hour faster on your bike, etc.).

3. Limit alcohol. There's a well-defined link between drinking and breast cancer risk: The more alcohol you consume, the greater the danger. Women who have two to five alcoholic drinks a day have about 1.5 times the cancer risk of those who don't drink any. Limit yourself to no more than one alcoholic beverage a day (typically a 12-oz beer, a 5-oz glass of wine or 1.5 oz of liquor).

4. Know your family history. If your mother, grandmother or maternal aunt developed breast cancer at age 50 or earlier, you may carry the gene mutation BRCA1 or BRCA2, which can place your lifetime risk of breast cancer at 60 percent (and your risk of ovarian cancer at 15 to 40 percent). Talk to your doctor about genetic testing and find out what protective actions you can take.

5. Eat healthy. Research shows that a diet rich in fruits, vegetables, fish, olive oil, whole grains and legumes is linked to a reduced risk of breast cancer in post-menopausal women. A recent study also showed that women who carried the BRCA mutation and ate a wide variety of fruits andvegetables had up to a 73 percent lower risk of breast cancer than women with the mutation who didn't eat their veggies.

6. Check your D levels. Although some experts say the link between vitamin D and breast cancer is uncertain, a few studies have highlighted a connection. One study found that higher levels of D meant a 50 percent lower risk of breast cancer. Another revealed that women who got a lot of vitamin D from diet, supplements or spending time outdoors were 25 to 45 percent less likely to develop breast cancer than those with lower levels.

6 Things that Definitely Won't Give You Cancer

1. Deodorant or Antiperspirant. Despite the persistent rumors, experts are unanimous in emphasizing that the stuff that keeps you dry won't boost your risk. In fact, a 2002 epidemiologic study of about 1,600 women found no link between breast cancer risk and antiperspirant or deodorant use. Photo: Brigitte Sporrer/Getty

2. Underwire bras. Another oft-reported myth: The wire is said to compress the lymphatic system, causing "toxins" to accumulate and lead to cancer. Pure nonsense, says Dr. Bevers. No clothing can increase your cancer risk.

3. Caffeine. Although it can make some breasts feel lumpier, multiple studies have shown that there's no connection between caffeine consumption and cancer. In fact, a recent Harvard study found that women who drank four or more cups of coffee a day had the same risk of breast cancer as women who drank none.

4. Your yearly mammogram. The amount of radiation you receive from a mammogram is extremely small—about as much as you would get flying from New York to California in a commercial jet, according to the American Cancer Society.

5. Having big breasts. This is one area where size truly doesn't matter. Anyone with breasts is at risk of developing cancer! However, if your breasts are dense—and they can be dense at any size—you may want to talk to your doctor about additional screening methods beyond mammograms. Up to 35 percent of breast cancer goes undetected by mammography, and this is most often a problem when breasts are very dense.

6. Breast implants. There's no connection between surgical enhancement and cancer risk, says Cynara Coomer, MD, chief of breast surgery at Staten Island University Hospital and an assistant clinical professor of surgery at Mount Sinai School of Medicine in New York. But keep in mind that implants may make it more difficult for a radiologist to read your mammograms. "You may have to have more images taken, and it can be uncomfortable to move the implant out of the way during the mammogram."

"I Found a Lump. Now What?"

A "don't panic" guide if you do find something that doesn't feel right

1. Stay calm. It's hard not to freak out, but take some comfort in the fact that the vast majority of lumps end up being a fatty nodule or some other noncancerous mass, says Dr. Coomer.

2. If you can stand to wait, go through your menstrual cycle, cut out the caffeine and see if the lump is still there in a couple of weeks.

3. Call your health care provider. She may refer you to a breast specialist or send you for a mammogram and/or ultrasound. If a lump is found, you may need to get a needle biopsy, a procedure in which a needle is inserted into your breast to take a sample of cells to figure out what's causing the lump. But this still doesn't mean it's cancer. In fact, about 80 percent of breast biopsies find benign lumps. Photo: ThinkStock

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9 Surprising Allergy Triggers

The cause of your sneezing, itchy nose, watery eyes, headache and a host of other symptoms may be more surprising than you think. You already know the usual suspects: pet dander, mold, pollen and dust. But could something else be causing your allergy symptoms? Our experts say yes indeed. Check out our list of allergens and allergy triggers you may have never before considered.

1. Chocolate

For some people, eating chocolate can be as uncomfortable as standing in a field of pollen during the peak of spring. Your favorite chocolate bar can bring on classic allergy symptoms, says Steven Y. Park, MD, an otolaryngologist in private practice in New York and the author of Sleep, Interrupted: A Physician Reveals the #1 Reason Why So Many of Us Are Sick and Tired. "Chocolate can irritate your nose's nervous system," he says. "Think of it as being like a migraine, where nerve endings in your nose become overly reactive." Incidentally, he adds, chocolate, along with red wine, MSG and aged cheeses, is a known migraine trigger.

2. Cloudy Weather

A lot of people complain about feeling a little down when the sun is hiding, but could clouds and rain actually bring on allergies? Certified food allergy safety educator Aleasa Word in Newark, Delaware, says yes. "When the weather changes and it gets cold, my 9-year-old son breaks out in hives and eczema on his hands and legs," she says. "We have to make sure he has several layers on to reduce the effect, and he takes an antihistamine medication each day before going out in the cold weather." Weather fluctuations such as temperature, air pressure and humidity changes can absolutely bring on allergy symptoms, adds Ronald Stram, MD, founder of the Center for Integrative Health and Healing in Delmar, New York. "This is also a common reason for sinus pain, pressure and headaches, which are often treated as if you had a sinus infection."

3. Stress

Have you ever been so stressed out that you started sneezing? It happens, says Elizabeth Lombardo, PhD, MS, PT, a psychologist in private practice in Wexford, Pennsylvania. "Stress induces a physiological reaction of certain chemicals including histamines, which lead to allergy symptoms. And although stress doesn't actually cause allergies per se, research shows it can make allergy symptoms much worse: immediately and even the next day."

4. Sperm

Allergic to sex? Maybe. According to experts, as many as 40,000 women in the United States suffer from what is known as seminal plasma hypersensitivity, an allergy to semen that can cause hives, itching, swelling and breathing difficulties. In severe cases, it can even cause death. "This occurs when the body's immune system overreacts when it encounters semen," says Dr. Stram. "The white blood cells mistakenly identify proteins in the semen as harmful invaders, such as bacteria or viruses, and launch an attack against them." What to do if you suspect a sperm allergy? Use condoms, of course, but also speak to a doctor immediately to rule out other sexually transmitted infections. To learn more about unusual physical responses to sex, check out 9 Surprising Post-Intercourse Reactions.

5. Cell Phones

We spend so much time with our cell phones that it's no wonder doctors are reporting an uptick in so-called cell phone "allergies." Some people may be surprised to find out that the rash on their cheek is from an allergy to nickel, which some phones are coated in. For others, it may just be a case of garden-variety contact dermatitis. This inflammation of the skin, explains Dr. Stram, is generally benign, but can cause red, itchy bumps. While the situation can most easily be traced to a dirty phone (remember to gently wipe yours with a disinfecting wipe every few days), the cause could also be diet related. "There is evidence that skin sensitivity may be a result of deficiencies in nutrients such as essential fatty acids, zinc, vitamin D and probiotics."

6. Wine

Love pinot noir, chardonnay or merlot? For some, even just a little sip can bring on red, blotchy skin and flu-like symptoms. But can one really be allergic to wine? Yes, says Dr. Stram. "This can be [the result of] several different allergies or sensitivities," he explains. "People who are allergic to wine can be allergic to yeast, sulfites, phenols or to the grapes themselves. The white blood cells mistakenly identify proteins in the wine as harmful invaders, such as bacteria or viruses, and launch an attack against it." But if you're a new wine drinker, don't expect your body to react immediately—wine allergies can take time to develop. "Typically, an allergic response is not triggered the first time the body encounters the protein, or allergen," he says. "The first time or several times after the body is exposed to the allergen, the immune system becomes sensitized."

7. Perfumes and Colognes

Does a certain coworker's cologne make your eyes burn? Do you sneeze every time you pass by his desk? If so, you may have scent sensitivities. According to some estimates, as many as a quarter of the U.S. population suffers from allergic rhinitis. Symptoms can include watery eyes, sneezing, runny nose and even difficulty breathing. "This is due to an extra-sensitive nervous system in your nose that overreacts to certain stimulants," says Dr. Park. Perfumes have become such an issue that some workplaces have banned them entirely. For instance, after an employee said that her colleague's perfume made it "challenging" to do her job, the city of Detroit made a new rule: no scented body products, aftershave, perfumes or colognes allowed.

8. Houseplants

They supposedly purify the air in our homes, but that neglected houseplant in the corner of your living room may also bring on a bad case of hay fever, say experts. According to researchers in Belgium, exposure to certain plants can cause sneezing and a runny nose. If you're sneezing more than usual this season, consider setting your houseplants outside for a day or two to see if your allergies improve. The worst-offending plants? Palms, orchids, ficus and ferns are known to be the biggest allergy inducers.

9. The Sun

Cloudy weather isn't the only allergy culprit, according to experts. For some people, the sun can bring on painful rashes and hive-like bumps. It's a condition commonly called a "sun allergy," but its true name is photosensitivity. "This occurs when the body's immune system overreacts to sunlight exposure," says Dr. Stram. "The sun causes a reaction in the skin which changes the protein component of the skin, producing an inflammatory cell reaction which releases histamine. Chemicals in lotions, perfumes or oral medications (like antibiotics or diuretics) may also prompt the allergic reaction." If you suspect you have a sun allergy, talk to your doctor, who may recommend changing your medications or trying something called "phototherapy" treatment, which can help your skin build up a tolerance to the sun's rays.

All photos by Shutterstock.

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Women's Health: Cervical Cancer Prevention

Photo: © iStockphoto

WD health advisor Maurie Markman, MD, vice president for clinical research at M.D. Anderson Cancer Center in Texas offers expert advice about a new development in the fight against cervical cancer.

Q. How does the new cervical cancer vaccine compare to the old one?

A. Gardasil, a vaccine that's been available in the U.S. since 2006, now has some competition since the FDA recently approved Cervarix. As far as I know, they work equally well for cervical cancer prevention. (Both protect against the two strains of HPV—a very common sexually transmitted virus—that cause 70 percent of all cervical cancers.) The main difference is that Gardasil also protects against genital warts; in fact, it was recently FDA-approved for the prevention of warts in boys and young men. These warts can be uncomfortable and embarrassing, but they don't lead to cancer.

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Understanding Adult Anorexia

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Eating disorders aren't just a teen affliction. With more women being diagnosed with anorexia than ever before, health experts are quick to point out that this disorder doesn't practice age discrimination. We spoke to eating disorder experts, anorexia survivors and others affected by the condition to bring you the very latest on anorexia in women.

The Truth About Adult Anorexia

For the majority of her life, 44-year-old Angela Lackey, a writer from Midland, Michigan, says she rarely fussed about her weight or worried about eating. She had a normal body image and, at 125 pounds, was healthy and fit. But shortly after being diagnosed with a thyroid illness that contributed to a sudden weight loss, she says friends began to notice her thinning figure. "Many people had complimented me on how 'tiny' and 'good' I looked," she says. She didn't know it then, but those comments would fuel unhealthy eating behaviors that would lead to full-fledged anorexia in a downward spiral that nearly cost Lackey her life.

While anorexia can hit at all ages, most people assume that it's an adolescent disorder. "The most common cases of anorexia in women are among those who had some eating disorder symptoms when they were teens," says Sari Shepphird, PhD, a clinical psychologist and eating disorders specialist in Los Angeles and author of 100 Questions & Answers About Anorexia Nervosa. "But the most current scientific literature suggests a vulnerability to developing eating disorders throughout the lifespan. Recent studies, in fact, indicate that older patients are being seen in increasing numbers and eating disorders treatment centers have seen a significant increase in the number of patients over age 30." One prominent treatment center, the Renfrew Center (with 11 locations across the country), reported in 2005 that as many as 20 percent of their adult eating disorder patients said they were age 30 or older when they first encountered symptoms.

Why the upsurge in adult anorexia? It's simple, says Dr. Shepphird: an increasing and intense social pressure to be thin. "The pressure on adult women to equate thinness with attractiveness has increased in recent years, now resulting in 80 percent—four out of five—women reporting dissatisfaction with their appearance," she says. "More women today feel like they are not 'successful' as women unless they are thin, which leads to increased eating disordered behavior."

Looking back on the road that led Lackey to anorexia, she says she "developed a strong fear of gaining any of the weight back." And, in a vicious cycle, she began using food restriction as a way of controlling those fears and anxieties as well as job-related stress. By November 2007, she had her eating down to a shockingly strict regimen: a cup of yogurt for breakfast, two slices of deli turkey for lunch and one-third cup of rice for dinner.

In January 2008, Lackey dropped below 100 pounds. In the end, after a few frightening emergency room visits for heart problems, it was a photo taken by a friend that helped her see that she, indeed, had a problem. "There was a picture of me that showed me stripped to the bone—my arms, my skull, my neck—there was no body fat anywhere. I was shocked and asked my husband, "Is that what I look like?" For the first time, I felt frightened for my life and agreed to get help. In the end, it took several visits to treatment centers and meetings with eating disorder specialists before she began gaining weight again and beginning her recovery. "I am working on being comfortable with change, which feels threatening to a lot of people with anorexia and other eating disorders," says Lackey, who is now in recovery.

Stress and Dieting: Risk Factors for Adult Anorexia?

While societal pressures continue to be a factor contributing to eating disorders in women, Dr. Shepphird offers up another possible culprit: Stress. "We know that anorexia is also often precipitated by, or triggered by, an emotional life event or period of significant stress," she says. "Significant stress, when coupled with inadequate coping resources, can combine with other risk factors to increase a person's vulnerability to illness." Common stressful life events that are known to trigger anorexia, and other eating disorders in some women, include divorce, childbirth, widowhood and menopause. "Additionally, eating disorder experts believe that chronic dieting may pose a particular risk for anorexia and other eating disorders in women as they age," she adds.

Adult Anorexia's Secondary Victims: Families

Blake Hill, a resident of Marina del Ray, California, was 19 years old when his mother, then in her 40s, began struggling with severe anorexia. "My mom was a beautiful person inside and out," he says. But he watched as his 5'10" mom succumbed to anorexia. In the years that followed, she shrunk to a mere 71 pounds. The disease, he says, caused a lot of grief for his family and complicated his relationship with his mom.

"Anorexia nervosa is an illness that can devastate the whole family," says Dr. Shepphird. "The mood and personality changes that result from anorexia-related starvation can wreak havoc on close personal relationships and family ties." In May of last year, Hill's mother died of the disorder. "It's extremely sad that she had to find peace in death," he says. "She's missed seeing her grandchildren's lives—Noah is 8 and Lily is 5." While he's accepted his mom's death, and forgiven her for what she put him—and herself—through, he says his life has been changed, scarred even, by this disease. "I can spot an anorexic woman on the street today, and I usually offer up a silent prayer."

"Sadly, anorexia has been known to destroy the connectedness that was once shared in otherwise loving families," says Dr. Shepphird. "I often recommend that family members receive help and support as well."

Advice from Survivors: How to Beat Anorexia

Shannon Cutts, a recovering anorexic and advocate for eating disorders awareness who founded the eating disorders mentoring community MentorCONNECT and wrote Beating Ana: How to Outsmart Your Eating Disorder and Take Your Life Back, says the first step toward recovery for many women is what she calls finding a "key to life," or something worth living for. "Recovering from an eating disorder is not going to be easy, and you need an extremely motivational goal to reach for to keep you going when you feel like giving up," she says. "Examples could include wanting to have a child someday, wanting to be there for your children, wanting to help others who have eating disorders, wanting to be able to see the world and travel, wanting to get married or save the relationships that are important to you."

"Find a good eating disorder specialist," adds Lackey, "someone who understands anorexia and particularly those who develop it later in life. Many doctors will not see patients over the age of 30, and many still refuse to believe it can develop—with no previous history—in someone in their 30s or 40s or beyond." Finally, continues Cutts, "don't give up—ever. There is always something else you can do to save your own life."

How to Tell If You Need Help

In her book, 100 Questions & Answers About Anorexia Nervosa, Dr. Shepphird offers a list of key questions. "If you answer 'yes' to any of these questions, regardless of whether you fit the diagnostic criteria for an eating disorder, your attitudes and behaviors about food and weight may need to be addressed," she says.

Do You:

1.Constantly think about your food, weight or body image?

2. Have difficulty concentrating because of those thoughts?

3. Worry about what your last meal is doing to your body?

4. Experience guilt or shame about eating?

5. Find it difficult to eat in public?

6. Count calories whenever you eat or drink?

7. Still feel fat when others tell you that you are thin?

8. Obsess that your stomach, hips, thighs or buttocks are too big?

9. Weigh yourself several times daily?

10. Feel that the number on your scale determines your mood and outlook for the day?

11. Punish yourself with more exercise or restrictions if you don't like the number on the scale?

12. Exercise more than an hour every day to burn calories?

13. Exercise to lose weight, even if you are ill or injured?

14. Label foods as "good" and "bad"?

15. Vomit after eating?

16. Berate yourself if you eat a "forbidden" food and compensate by skipping your next meal?

17. Use laxatives or diuretics to keep your weight down?

18. Severely limit your food intake?

Sarah Jio is the health and fitness blogger for Glamour.com. Visit her blog, Vitamin G.

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